100TH GENERAL ASSEMBLY
State of Illinois
2017 and 2018
HB3391

 

Introduced , by Rep. Emanuel Chris Welch

 

SYNOPSIS AS INTRODUCED:
 
See Index

    Amends the Medical Assistance Article of the Illinois Public Aid Code. In provisions concerning payment rates for nursing facilities, provides that facility-specific staffing levels and wages paid (rather than regional wage adjusters based on the Health Service Areas (HSA) groupings and adjusters in effect on April 30, 2012) shall be one of the factors in determining the new nursing services reimbursement methodology utilizing the RUG-IV 48 grouper model. Sets forth the calculation of the facility-specific RUG-IV nursing component per diem rate for dates of service beginning July 1, 2017. Provides that certain staffing and wage adjusters must be updated each quarter using the staffing hours and wage data from Payroll Benefit Journal data collected by the Centers for Medicare and Medicaid Services for the same time period of Minimum Date Set data used to calculate the RUG-IV acuity case weight. Sets forth how to calculate each facility's "total per resident per day staffing wage cost". Provides that the levels used to assign certain staffing and wage adjusters shall be calculated using the staffing ratios required under the Nursing Home Care Act multiplied by the Illinois mean hourly wage for the equivalent occupational code and title assigned by the U.S. Bureau of Labor Statistics and reported in the May 2014 State Occupational Employment and Wage Estimates for Illinois. Provides that beginning July 1, 2017 and quarterly thereafter, the Department of Healthcare and Family Services may adjust, by administrative rule and within certain parameters established under the Code, a specific staffing and wage adjuster described in the Code for the purpose of keeping liability created by the facility-specific RUG-IV nursing component per diem rates stable. Permits the Department to adopt rules to implement these provisions. Effective immediately.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

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1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 1. Findings. The General Assembly finds as follows:
5        (1) It is in the best interest of the citizens of
6    Illinois to review and update Medicaid payment
7    methodologies to ensure the best use of public resources.
8        (2) The intent of the $6.07 tax per occupied bed day
9    imposed by Public Act 96-1530 was to pay for increased
10    staffing under Public Act 96-1372.
11        (3) Many nursing homes are still staffed below the
12    legal level required under Section 3-202.05 of the Nursing
13    Home Care Act.
14        (4) Some low-staffed homes have gained from the higher
15    Medicaid rates but have not increased staffing.
16        (5) Policy research has noted the significant positive
17    relationship between nursing home staffing levels and
18    quality of care.
19        (6) The State of Illinois desires to pay for value and
20    quality not just volume.
21        (7) The use of regional wage adjusters rewards or
22    penalizes nursing homes solely on location and does not
23    account for staffing levels or actual wages paid.
 

 

 

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1    Section 5. The Illinois Public Aid Code is amended by
2changing Section 5-5.2 as follows:
 
3    (305 ILCS 5/5-5.2)  (from Ch. 23, par. 5-5.2)
4    Sec. 5-5.2. Payment.
5    (a) All nursing facilities that are grouped pursuant to
6Section 5-5.1 of this Act shall receive the same rate of
7payment for similar services.
8    (b) It shall be a matter of State policy that the Illinois
9Department shall utilize a uniform billing cycle throughout the
10State for the long-term care providers.
11    (c) Notwithstanding any other provisions of this Code, the
12methodologies for reimbursement of nursing services as
13provided under this Article shall no longer be applicable for
14bills payable for nursing services rendered on or after a new
15reimbursement system based on the Resource Utilization Groups
16(RUGs) has been fully operationalized, which shall take effect
17for services provided on or after January 1, 2014.
18    (d) The new nursing services reimbursement methodology
19utilizing RUG-IV 48 grouper model, which shall be referred to
20as the RUGs reimbursement system, taking effect January 1,
212014, shall be based on the following:
22        (1) The methodology shall be resident-driven,
23    facility-specific, and cost-based.
24        (2) Costs shall be annually rebased and case mix index
25    quarterly updated. The nursing services methodology will

 

 

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1    be assigned to the Medicaid enrolled residents on record as
2    of 30 days prior to the beginning of the rate period in the
3    Department's Medicaid Management Information System (MMIS)
4    as present on the last day of the second quarter preceding
5    the rate period based upon the Assessment Reference Date of
6    the Minimum Data Set (MDS).
7        (3) Facility-specific staffing levels and wages paid.
8    Regional wage adjustors based on the Health Service Areas
9    (HSA) groupings and adjusters in effect on April 30, 2012
10    shall be included.
11        (4) Case mix index shall be assigned to each resident
12    class based on the Centers for Medicare and Medicaid
13    Services staff time measurement study in effect on July 1,
14    2013, utilizing an index maximization approach.
15        (5) The pool of funds available for distribution by
16    case mix and the base facility rate shall be determined
17    using the formula contained in subsection (d-1).
18    (d-1) Calculation of base year Statewide RUG-IV nursing
19base per diem rate, for dates of service beginning January 1,
202014 through June 30, 2017.
21        (1) Base rate spending pool shall be:
22            (A) The base year resident days which are
23        calculated by multiplying the number of Medicaid
24        residents in each nursing home as indicated in the MDS
25        data defined in paragraph (4) by 365.
26            (B) Each facility's nursing component per diem in

 

 

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1        effect on July 1, 2012 shall be multiplied by
2        subsection (A).
3            (C) Thirteen million is added to the product of
4        subparagraph (A) and subparagraph (B) to adjust for the
5        exclusion of nursing homes defined in paragraph (5).
6        (2) For each nursing home with Medicaid residents as
7    indicated by the MDS data defined in paragraph (4),
8    weighted days adjusted for case mix and regional wage
9    adjustment shall be calculated. For each home this
10    calculation is the product of:
11            (A) Base year resident days as calculated in
12        subparagraph (A) of paragraph (1).
13            (B) The nursing home's regional wage adjustor
14        based on the Health Service Areas (HSA) groupings and
15        adjustors in effect on April 30, 2012.
16            (C) Facility weighted case mix which is the number
17        of Medicaid residents as indicated by the MDS data
18        defined in paragraph (4) multiplied by the associated
19        case weight for the RUG-IV 48 grouper model using
20        standard RUG-IV procedures for index maximization.
21            (D) The sum of the products calculated for each
22        nursing home in subparagraphs (A) through (C) above
23        shall be the base year case mix, rate adjusted weighted
24        days.
25        (3) The Statewide RUG-IV nursing base per diem rate:
26            (A) on January 1, 2014 shall be the quotient of the

 

 

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1        paragraph (1) divided by the sum calculated under
2        subparagraph (D) of paragraph (2); and
3            (B) on and after July 1, 2014, shall be the amount
4        calculated under subparagraph (A) of this paragraph
5        (3) plus $1.76.
6        (4) Minimum Data Set (MDS) comprehensive assessments
7    for Medicaid residents on the last day of the quarter used
8    to establish the base rate.
9        (5) Nursing facilities designated as of July 1, 2012 by
10    the Department as "Institutions for Mental Disease" shall
11    be excluded from all calculations under this subsection.
12    The data from these facilities shall not be used in the
13    computations described in paragraphs (1) through (4) above
14    to establish the base rate.
15    (e) Beginning July 1, 2014, the Department shall allocate
16funding in the amount up to $10,000,000 for per diem add-ons to
17the RUGS methodology for dates of service on and after July 1,
182014:
19        (1) $0.63 for each resident who scores in I4200
20    Alzheimer's Disease or I4800 non-Alzheimer's Dementia.
21        (2) $2.67 for each resident who scores either a "1" or
22    "2" in any items S1200A through S1200I and also scores in
23    RUG groups PA1, PA2, BA1, or BA2.
24    (e-1) (Blank).
25    (e-2) For dates of services beginning January 1, 2014
26through June 30, 2017, the RUG-IV nursing component per diem

 

 

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1for a nursing home shall be the product of the statewide RUG-IV
2nursing base per diem rate, the facility average case mix
3index, and the regional wage adjustor. Transition rates for
4services provided between January 1, 2014 and December 31, 2014
5shall be as follows:
6        (1) The transition RUG-IV per diem nursing rate for
7    nursing homes whose rate calculated in this subsection
8    (e-2) is greater than the nursing component rate in effect
9    July 1, 2012 shall be paid the sum of:
10            (A) The nursing component rate in effect July 1,
11        2012; plus
12            (B) The difference of the RUG-IV nursing component
13        per diem calculated for the current quarter minus the
14        nursing component rate in effect July 1, 2012
15        multiplied by 0.88.
16        (2) The transition RUG-IV per diem nursing rate for
17    nursing homes whose rate calculated in this subsection
18    (e-2) is less than the nursing component rate in effect
19    July 1, 2012 shall be paid the sum of:
20            (A) The nursing component rate in effect July 1,
21        2012; plus
22            (B) The difference of the RUG-IV nursing component
23        per diem calculated for the current quarter minus the
24        nursing component rate in effect July 1, 2012
25        multiplied by 0.13.
26    (e-3) Calculation of facility-specific RUG-IV nursing

 

 

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1component per diem rate for dates of service beginning July 1,
22017.
3        (1) The facility-specific RUG-IV nursing component per
4    diem rate must be the product of:
5            (A) The Statewide RUG-IV base rate of $85.25.
6            (B) The staffing and wage adjuster which is
7        assigned per facility based on the facility's specific
8        total per resident per day staffing wage cost as
9        defined in paragraph (2) of this subsection. For levels
10        defined in paragraph (3) of this subsection, the
11        staffing wage adjuster is:
12                (i) 0.80 for a facility with a total per
13            resident per day staffing wage cost less than level
14            1, or a facility whose staffing level is below the
15            intermediate care minimum required under Section
16            3-202.05 of the Nursing Home Care Act even if the
17            facility has a total per resident per day staffing
18            wage cost greater than or equal to level 1;
19                (ii) 1.22 for a facility with a total per
20            resident per day staffing wage cost greater than or
21            equal to level 1 but less than level 2;
22                (iii) 1.42 for a facility with a total per
23            resident per day staffing wage cost greater than or
24            equal to level 2 but less than level 3;
25                (iv) 1.45 for a facility with a total per
26            resident per day staffing wage cost greater than or

 

 

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1            equal to level 3; or
2                (v) 0.80 for a facility without data necessary
3            to calculate the facility's specific total per
4            resident per day staffing wage cost as defined in
5            paragraph (2) of this subsection.
6            (C) The facility weighted case mix, which is the
7        number of Medicaid residents as indicated by the
8        Minimum Data Set (MDS) data defined in paragraph (4) of
9        this subsection multiplied by the associated case
10        weight for the RUG-IV 48 grouper model using standard
11        RUG-IV procedures for index maximization.
12            (D) The ratio of actual staffing hours to total
13        expected staffing hours adjuster which is assigned
14        based on each facility's ratio as defined in paragraph
15        (5) of this subsection. The facilities are divided into
16        4 quartiles sorted from lowest to highest based on the
17        facility's ratio. The quartile with the lowest ratios
18        is quartile 1 and the quartile with the highest ratios
19        is quartile 4 with quartile 2 and quartile 3 assigned
20        based on the ratios in those quartiles in relation to
21        lowest and highest quartiles. Facilities without
22        reported data are assigned to quartile 3. The quartiles
23        are calculated quarterly during regular rate updates.
24        The adjuster for each quartile is as follows:
25                (i) 0.65 for facilities in quartile 1;
26                (ii) the ratio defined in paragraph (5) of this

 

 

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1            subsection for facilities in quartile 2 and 3; or
2                (iii) 1.00 for facilities in quartile 4.
3        (2) The staffing and wage adjuster under subparagraph
4    (B) of paragraph (1) of this subsection must be updated
5    each quarter using the staffing hours and wage data from
6    Payroll Benefit Journal data collected by the Centers for
7    Medicare and Medicaid Services for the same time period of
8    MDS data used to calculate the RUG-IV acuity case weight.
9    For the purposes of this Section, each facility's "total
10    per resident per day staffing wage cost" is calculated by
11    summing:
12            (A) The product of registered nurses' hours worked
13        per resident day multiplied by the reported hourly
14        wage. For the Director of Nursing only the number of
15        hours allowed under Section 3-202.05 of the Nursing
16        Home Care Act for the calculation of staffing ratios
17        may be included; plus
18            (B) The product of licensed practical nurses'
19        worked hours per resident day multiplied by the
20        reported hourly wage; plus
21            (C) The product of certified nurse assistants'
22        hours worked per resident day multiplied by the
23        reported hourly wage; plus
24            (D) For all other staff considered direct care
25        staff under staffing ratios described in Section
26        3-202.05 of the Nursing Home Care Act, the product of

 

 

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1        each remaining direct care staff type hours worked per
2        resident day multiplied by the reported hourly wage for
3        the direct care staff category at the same levels
4        allowed under the staffing ratios under Section
5        3-202.05 of the Nursing Home Care Act.
6        (3) The levels used to assign the staffing and wage
7    adjuster under subparagraph (B) of paragraph (1) of this
8    subsection shall be calculated using the staffing ratios
9    required under Section 3-202.05 of the Nursing Home Care
10    Act multiplied by the Illinois mean hourly wage for the
11    equivalent occupational code and title assigned by the U.S.
12    Bureau of Labor Statistics and reported in the May 2014
13    State Occupational Employment and Wage Estimates for
14    Illinois. The Department may, as established by rule, use
15    more current data from the same data set when made
16    available. The levels are:
17            (A) Level 1 is equal to the sum of:
18                (i) The product of 10% of the minimum staffing
19            hours per resident day for intermediate care under
20            Section 3-202.05 of the Nursing Home Care Act
21            multiplied by the Illinois mean hourly wage for
22            registered nurses occupation code 29-1141 from the
23            U.S. Bureau of Labor Statistics data set described
24            in paragraph (3) of this subsection; plus
25                (ii) The product of 15% of the minimum staffing
26            hours per resident day for intermediate care under

 

 

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1            Section 3-202.05 of the Nursing Home Care Act
2            multiplied by the Illinois mean hourly wage for
3            licensed practical nurses occupation code 29-2061
4            from the U.S. Bureau of Labor Statistics data set
5            described in paragraph (3) of this subsection;
6            plus
7                (iii) The product of 75% of the minimum
8            staffing hours per resident day for intermediate
9            care under Section 3-202.05 of the Nursing Home
10            Care Act multiplied by the Illinois mean hourly
11            wage for nursing assistants occupation code
12            31-1014 from the U.S. Bureau of Labor Statistics
13            data set described in paragraph (3) of this
14            subsection.
15            (B) Level 2 is equal to the sum of:
16                (i) The product of 10% of the minimum staffing
17            hours per resident day for skilled care under
18            Section 3-202.05 of the Nursing Home Care Act
19            multiplied by the Illinois mean hourly wage for
20            registered nurses occupation code 29-1141 from the
21            U.S. Bureau of Labor Statistics data set described
22            in paragraph (3) of this subsection; plus
23                (ii) The product of 15% of the minimum staffing
24            hours per resident day for skilled care under
25            Section 3-202.05 of the Nursing Home Care Act
26            multiplied by the Illinois mean hourly wage for

 

 

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1            licensed practical nurses occupation code 29-2061
2            from the U.S. Bureau of Labor Statistics set
3            described in paragraph (3) of this subsection;
4            plus
5                (iii) The product of 75% of the minimum
6            staffing hours per resident day for skilled care
7            under Section 3-202.05 of the Nursing Home Care Act
8            multiplied by the Illinois mean hourly wage for
9            nursing assistants occupation code 31-1014 from
10            the U.S. Bureau of Labor Statistics data set
11            described in paragraph (3) of this subsection.
12            (C) Level 3 is equal to the sum of:
13                (i) The product of .84 staffing hours per
14            resident day multiplied by the Illinois mean
15            hourly wage for registered nurses occupation code
16            29-1141 from the U.S. Bureau of Labor Statistics
17            data set described in paragraph (3) of this
18            subsection; plus
19                (ii) The product of .84 staffing hours per
20            resident day multiplied by the Illinois mean
21            hourly wage for licensed practical nurses
22            occupation code 29-2061 from the U.S. Bureau of
23            Labor Statistics data set described in paragraph
24            (3) of this subsection; plus
25                (iii) The product of 2.46 staffing hours per
26            resident day multiplied by the Illinois mean

 

 

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1            hourly wage for nursing assistants occupation code
2            31-1014 from the U.S. Bureau of Labor Statistics
3            data set described in paragraph (3) of this
4            subsection.
5        (4) Minimum Data Set comprehensive assessments for
6    Medicaid residents on the last day of the quarter used to
7    establish the rate.
8        (5) The facility-specific total ratio of actual
9    staffing hours to total expected staffing hours for the
10    assigned resident specific case weight must be updated each
11    quarter using the staffing hours and wage data from Payroll
12    Benefit Journal data collected by the Centers for Medicare
13    and Medicaid Services for the same time period of MDS data
14    used to calculate the RUG-IV acuity case weight. For each
15    facility the Department must calculate the total hours
16    worked per resident day for direct care staff allowed by
17    the staffing ratios under Section 3-202.05 of the Nursing
18    Home Care Act and divide that value by the sum of staffing
19    hours per resident day assigned to each resident based on
20    the sum of the Resident Specific Time and Direct
21    Non-Resident Specific Time for the resident's RUG-IV
22    group. This is the same methodology for the Medicare 5-star
23    rating program calculation of the expected staffing hours
24    per resident day used by the Centers for Medicare and
25    Medicaid Services, except that the Centers for Medicare and
26    Medicaid Services uses RUG-III groupings.

 

 

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1        (6) If the Payroll Benefit Journal data collected by
2    the Centers for Medicare and Medicaid Services is not
3    available, the Department must use the most recent cost
4    reporting data reported to the Department and the most
5    recent survey data posted to the Centers for Medicare and
6    Medicaid Services' Nursing Home Compare website. The
7    Department must use the Payroll Benefit Journal data
8    collected by the Centers for Medicare and Medicaid Services
9    once the data is available.
10    (e-4) Budget stability beginning July 1, 2017.
11        (1) Beginning July 1, 2017 and quarterly thereafter,
12    the Department may adjust, by administrative rule and
13    within the parameters established under this subsection
14    (e-4), the staffing and wage adjuster described in
15    subparagraph (B) of paragraph (1) of subsection (e-3) and
16    the ratio of actual staffing hours to the total expected
17    staffing hours adjuster described in subparagraph (D) of
18    paragraph (1) of subsection (e-3) for the purpose of
19    keeping liability created by the facility-specific RUG-IV
20    nursing component per diem rates stable as defined in
21    paragraph (2) and paragraph (3) of this subsection (e-4).
22        (2) Budget stability for facility-specific RUG-IV
23    nursing component per diem rates effective July 1, 2017
24    through June 30, 2019. If the aggregate budget stability
25    ratio calculated under paragraph (4) of this subsection is
26    greater than 0.96, then the Department must adjust one or

 

 

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1    both of the adjusters specified in paragraph (1) of this
2    subsection in order to decrease the ratio to no less than
3    0.96.
4        (3) Budget stability for facility-specific RUG-IV
5    nursing component per diem rates effective July 1, 2019 and
6    quarterly thereafter. If the aggregate budget stability
7    ratio calculated under paragraph (4) of this subsection is
8    between 0.98 and 1.00, the Department must not make any
9    adjustments. If the aggregate budget stability ratio
10    calculated under paragraph (4) of this subsection is less
11    than 0.98, then the Department must adjust one or both of
12    the adjusters specified in paragraph (1) of this subsection
13    in order to increase the ratio to at least 0.98. If the
14    aggregate budget stability ratio calculated under
15    paragraph (4) of this subsection is greater than 1.00, then
16    the Department must adjust one or both of the adjusters
17    specified in paragraph (1) of this subsection in order to
18    decrease the ratio to at least 1.00, but no less than 1.00.
19        (4) For the purposes of this Section, the aggregate
20    budget stability ratio calculated with the numerator
21    described in subparagraph (A) of this paragraph (4) divided
22    by the denominator described in subparagraph (B) of this
23    paragraph (4) is as follows:
24            (A) Numerator equal to the sum of the following
25        products:
26                (i) the product of the number of Medicaid

 

 

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1            residents in each nursing home as indicated in the
2            MDS data defined in paragraph (4) of subsection
3            (e-3) multiplied by 365; then multiplied by
4                (ii) each nursing home's specific rate under
5            paragraph (1) of subsection (e-3). This rate does
6            not include the per diem add-ons defined in
7            subsection (e) of this Section.
8            (B) Denominator equal to the sum of the following
9        products:
10                (i) the product of the number of Medicaid
11            residents in each nursing home as indicated in the
12            MDS data defined in paragraph (4) of subsection
13            (e-3) multiplied by 365; then multiplied by
14                (ii) each nursing home's specific rate
15            effective July 1, 2015 under subsection (e-2) as
16            adjusted by any past or future MDS validation
17            reviews performed by the Department. This rate
18            does not include the per diem add-ons defined in
19            subsection (e) of this Section.
20        (5) If adjustments are necessary under this subsection
21    (e-4), the staffing and wage adjuster described in
22    subparagraph (B) of paragraph (1) of subsection (e-3) must
23    be adjusted within the following parameters:
24            (A) the adjuster for facilities with a total per
25        resident per day staffing wage cost less than level 1
26        must never be greater than 0.80;

 

 

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1            (B) the adjuster for facilities with a total per
2        resident per day staffing wage cost less than level 1
3        must be lower than the adjusters for the other levels;
4            (C) the adjuster for facilities with a total per
5        resident per day staffing wage cost less than level 1
6        must generate an aggregate cost coverage for nursing
7        homes qualifying for that adjuster less than or equal
8        to 70% using the most recent cost data from cost
9        reports filed with the Department. The cost coverage
10        for the nursing homes qualifying for that adjuster must
11        have the lowest cost coverage as compared to the other
12        3 groups;
13            (D) the adjusters for the middle 2 levels must
14        generate the best possible aggregate cost coverage for
15        nursing homes qualifying for those adjusters of all the
16        adjusters using the most recent cost data from cost
17        reports filed with the Department; and
18            (E) the adjuster for facilities with a total per
19        resident per day staffing wage cost greater than level
20        4 must generate an aggregate cost coverage for nursing
21        homes qualifying for that adjuster less than or equal
22        to 80% using the most recent cost data from cost
23        reports filed with the Department.
24            (F) Any limitations in this paragraph (5) based on
25        cost coverage must use the most recent cost data from
26        cost reports filed with the Department and must be

 

 

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1        calculated after any adjustments have been made to the
2        ratio of actual staffing hours to total expected
3        staffing hours adjuster described in subparagraph (D)
4        of paragraph (1) of subsection (e-3) and limited by
5        paragraph (6) of this subsection (e-4).
6        (6) If adjustments are necessary under this subsection
7    (e-4), the ratio of actual staffing hours to total expected
8    staffing hours adjuster described in subparagraph (D) of
9    paragraph (1) of subsection (e-3) must be adjusted within
10    the following parameters:
11            (A) the adjuster for quartile 4 which has the best
12        acuity based staffing ratio must never be less than
13        1.00;
14            (B) the adjuster for quartile 1 must be the
15        smallest of all 4 quartile adjusters and must never be
16        greater than 0.65;
17            (C) the Department may set a specific adjuster for
18        quartile 2 and quartile 3 as opposed to the
19        facility-specific ratio defined in paragraph (5) of
20        subsection (e-3) which is allowed under subparagraph
21        (D) of paragraph (1) of subsection (e-3). If the
22        Department sets a specific adjuster for quartile 2 or
23        quartile 3, then the adjuster for quartile 3 must not
24        be greater than the adjuster for quartile 4 or less
25        than the adjuster for quartile 2. The adjuster for
26        quartile 2 must not be greater than the adjuster for

 

 

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1        quartile 3 or less than the adjuster for quartile 1;
2        and
3            (D) no quartile may have an adjuster greater than
4        1.00.
5        (7) For the purposes of this Section, cost coverage for
6    a facility is the facility-specific RUG-IV nursing
7    component per diem rate divided by the healthcare program
8    cost per day. The healthcare program cost per day is
9    calculated using data from cost reports submitted to the
10    Department as required under this Code and the Department's
11    administrative rules. The Department may update the cost
12    report references in this paragraph by administrative rule
13    should the Department's cost report be altered, as long as
14    the updated references result in identification of the
15    identical or equivalent data and does not materially change
16    the resulting calculations. If the Department has made
17    changes from an audit, the Department may use column 10
18    instead of column 8 of the respective cost report lines
19    cited in this paragraph (7) if the information is made
20    publicly available at the time of making any calculations
21    required in this Section. The healthcare program cost per
22    day is the quotient of:
23            (A) the sum of the following costs as reported on
24        schedule V. of the Department's cost report;
25                (i) the total adjusted health care and
26            programs costs as reported on line 16 column 8;

 

 

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1            plus
2                (ii) the total adjusted provider participation
3            fee costs as reported on line 42 column 8; plus
4                (iii) the total allocated cost of employee
5            benefits for health care employees calculated as
6            the total adjusted health care and programs salary
7            and wage costs as reported on line 16 column 1
8            divided by the product of the grand total salary
9            and wages as reported on line 45 column 1
10            multiplied by the total adjusted employee benefits
11            and payroll taxes as report on line 22 column 8;
12            (B) divided by the total patient days reported on
13        schedule III line 14 column 5 of the Department's cost
14        report.
15    (f) Notwithstanding any other provision of this Code, on
16and after July 1, 2012, reimbursement rates associated with the
17nursing or support components of the current nursing facility
18rate methodology shall not increase beyond the level effective
19May 1, 2011 until a new reimbursement system based on the RUGs
20IV 48 grouper model has been fully operationalized.
21    (g) Notwithstanding any other provision of this Code, on
22and after July 1, 2012, for facilities not designated by the
23Department of Healthcare and Family Services as "Institutions
24for Mental Disease", rates effective May 1, 2011 shall be
25adjusted as follows:
26        (1) Individual nursing rates for residents classified

 

 

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1    in RUG IV groups PA1, PA2, BA1, and BA2 during the quarter
2    ending March 31, 2012 shall be reduced by 10%;
3        (2) Individual nursing rates for residents classified
4    in all other RUG IV groups shall be reduced by 1.0%;
5        (3) Facility rates for the capital and support
6    components shall be reduced by 1.7%.
7    (h) Notwithstanding any other provision of this Code, on
8and after July 1, 2012, nursing facilities designated by the
9Department of Healthcare and Family Services as "Institutions
10for Mental Disease" and "Institutions for Mental Disease" that
11are facilities licensed under the Specialized Mental Health
12Rehabilitation Act of 2013 shall have the nursing,
13socio-developmental, capital, and support components of their
14reimbursement rate effective May 1, 2011 reduced in total by
152.7%.
16    (i) On and after July 1, 2014, the reimbursement rates for
17the support component of the nursing facility rate for
18facilities licensed under the Nursing Home Care Act as skilled
19or intermediate care facilities shall be the rate in effect on
20June 30, 2014 increased by 8.17%.
21    (j) The Department may adopt rules in accordance with the
22Illinois Administrative Procedure Act to implement this
23Section. However, the requirements under this Section must be
24implemented by the Department even if the Department has not
25adopted rules by the implementation date of July 1, 2017.
26    (k) The new rates under the reimbursement methodology

 

 

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1created by this amendatory Act of the 100th General Assembly
2shall not be paid until approved by the Centers for Medicare
3and Medicaid Services.
4(Source: P.A. 98-104, Article 6, Section 6-240, eff. 7-22-13;
598-104, Article 11, Section 11-35, eff. 7-22-13; 98-651, eff.
66-16-14; 98-727, eff. 7-16-14; 98-756, eff. 7-16-14; 99-78,
7eff. 7-20-15.)
 
8    Section 99. Effective date. This Act takes effect upon
9becoming law.

 

 

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1 INDEX
2 Statutes amended in order of appearance
3    305 ILCS 5/5-5.2from Ch. 23, par. 5-5.2